Schwanoma gigante do VIII nervo craniano de evolução subaguda: relato de caso / Subacute evolution of giant schwannoma of VIII cranial nerve: case report

O schwanoma vestibular é uma neoplasia que se origina das células de Schwann da porção vestibular do VIII nervo craniano e que corres- ponde a cerca de 10% dos tumores intracranianos e a 80% a 90% daqueles localizados no ângulo pontocerebelar. Apesar do crescimento lento e evolução em geral benigna, estes tumores podem evoluir de maneira desfavorável devido à localização em compartimento anatômico relativamente reduzido no crânio (fossa posterior), o que pode levar a compressão de estruturas nobres (como o tronco encefálico) e a desenvolvimento de hidrocefalia obstrutiva, especialmente nos raros casos de schawanomas gigantes (> 40 mm). Apresentamos relato de caso de paciente com quadro de tinnitus e hipoacusia à esquerda que evoluiu de forma subaguda com alterações do humor, da cognição e da marcha cujo diagnóstico final foi de schwanoma gigante do VIII nervo craniano.

Vestibular schwannoma is a Schwann cells neoplasia of the vestibular branch of the VIII cranial nerve and it accounts for 10% of intracranial tumours and to 80%-90% of those located at the cerebellopontine angle. Despite slow growth and usual benign evolution, unfavourable outcomes may occur, especially in the rare cases of giant schwanno- mas (> 40mm). Owing the fact that this tumours are located in a relatively narrow space (posterior fossa), giant schwannomas may compress noble areas (as the brainstem), which can also cause obstructive hydrocephalus. We discuss a case report of a 48 years old woman complaining of left-sided hearing loss and tinnitus that developed a subacute cognitive impairment, mood disorder and gait disturbance, diagnosed with giant schwannoma of the VIII nerve.

Extracranial neurogenic tumors of the head and neck, / Tumores neurogênicos extracranianos na cabeça e pescoço

ABSTRACT INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Resumo INTRODUÇÃO: Tumores dos nervos periféricos tipicamente derivam das células de Schwann da bainha dos nervos periféricos. Por serem incomuns, devem ser lembrados no diagnóstico diferencial pré-operatório. OBJETIVO: Relatar a experiência de serviço de referencia terciária. MÉTODO: De 1977 a 2013, 42 pacientes com tumores neurogênicos periféricos da cabeça e pescoço foram operados e analisados retrospectivamente. A confirmação diagnóstica pré-operatória deu-se por biópsia ou método de imagem. RESULTADOS: A média da idade foi de 41,7 anos, sendo 15 indivíduos (36%) do gênero masculino. O tamanho médio foi de 5,5 cm e 26 (61%) localizavam-se na face lateral do pescoço. A maior parte (39,9%) apresentou-se como tumor palpável assintomático. A maioria (39,9%) foi ressecadapor acesso cervical. A maioria originou-se de nervos cranianos. CONCLUSÕES: Tumores neurogênicos extracranianos apresentam-se com tamanho médio de 5,5 cm, na face lateral do pescoço, costumam originar-se de nervos cranianos e ser ressecados por via cervical.

Schwannoma del nervio facial y sus ramas en el oído medio: reporte de 3 casos y revisión de literatura / Schwannoma of the facial nerve and its branches in the middle ear: a report of 3 cases and literature review

El schwannoma del nervio facial (SNF) es un tumor infrecuente, sin embargo es el tumor más frecuente del nervio facial. Son tumores benignos de crecimiento lento que producen sintomatología otológica no específica y pueden asociar parálisis facial. No existen exámenes preoperatorios que nos permitan diagnosticar con certeza el SNF. El estudio de elección se realiza con TC de alta resolución y RM con gadolinio. El diagnóstico definitivo es histopatológico pero se puede hacer diagnóstico presuntivo si la clínica, imágenes y hallazgo intraoperatorios son concordantes. El objetivo del tratamiento debe intentar preservar la función del nervio facial por el mayor tiempo posible. En casos de pacientes asintomáticos, o sin compromiso del nervio facial, se prefiere la observación. Se presentan en este artículo casos de schwannomas del facial intratimpánico y de cuerda del tímpano.

The facial nerve schwannoma (SNF) is a rare tumor, however it is the most common tumor of the facial nerve. They are slow-growing benign tumors that produce non-specific otologic symptoms and may be associated facial paralysis. There are no preoperative tests that allow us to accurately diagnose the SNF. The study of choice is made with high resolution CT and MRI with gadolinium. Definitive diagnosis is histopathological but the physician may make a presumptive diagnosis if clinical images and intraoperative findings are consistent. The goal of treatment should try to preserve facial nerve function for as long as possible. In cases of asymptomatic patients, without facial nerve involvement, observation is prefered. Cases of schwannomas of intratympanic facial and chorda tympani are presented in this article.

Schwannoma del nervio facial como diagnóstico diferencial de tumor parotídeo: reporte de un caso / Facial nerve Schwannoma resembling a parotid tumor: case report

Los schwannomas del nervio facial son lesiones benignas originadas de las células de Schwann, de crecimiento lento y predecible, generalmente asintomáticas. Sólo el 9 por ciento de los casos se ubica en la porción intraparotídea del nervio facial, lo cual obliga al diagnóstico diferencial con otros tumores parotídeos. Reportamos un caso de schwannoma del nervio facial izquierdo de ubicación intraparotídea, el cual fue confirmado mediante estimulación eléctrica intraoperatoria y resecado con intención conservadora del nervio facial. Además, se revisa la literatura actual sobre el tema.

Facial nerve Schwannomas are benign tumors that originate from Schwann cells, with a slow and predictable growth, and that are generally asymptomatic. Only 9 percent of these tumors are located in the intraparotid segment of the facial nerve. We report a 26 years old female presenting with a mass in the left parotid region lasting four months. The patient was subjected to a parotidectomy. During surgery, an encapsulated tumor whose origin was in the seventh cranial nerve and associated to a lymph node was found. The tumor was excised, trying to preserve the integrity of the nerve. The pathological diagnosis of the surgical piece disclosed a benign Schwannoma. The patient had a facial paralysis in the postoperative period.

Tumor do VIII nervo com apresentação incomum / An uncommon presentation of an VIII nerve tumor

Os Schwannomas vestibulares são responsáveis por 80 a 90 por cento dos tumores do ângulo ponto-cerebelar. A atual incidência é estimada em 0,8 por cento a 2,5 por cento da população mundial. A hipoacusia unilateral e progressiva é o sintoma mais precoce e freqüente, sendo o tinido a segunda queixa mais comum. Estudos demonstram que apenas 5 por cento dos pacientes com schwannoma vestibular têm exames audiométricos normais. No caso em foco é relatado hipoestesia da hemiface com diminuição do reflexo córneo palpebral ipsilateral, hipoestesia da porção póstero-superior do pavilhão auditivo (sinal de Hitzelberger positivo), diminuição do lacrimejamento, Romberg sensibilizado positivo. Observava-se discreto desvio da rima labial para a esquerda, não apresentando outras alterações nos demais pares cranianos. À acumetria, não havia alteração da sensibilidade auditiva em ambas as vias aéreas.

Vestibular Shwannomas are responsible for 80-90 percent of the cerebelar-pontine angle tumors and their incidence is of 0.8 to 20.5 percent of all tumors. Unilateral and progressive hearing loss is the most frequent and premature symptom, and tinnitus is the second most common complaint. Only 5 percent of the patients have normal audiograms. In this case the patient complained of ipsilateral facial numbness and weak blink, posterior pinna hypoesthesia (Hitzelberger +), tear reduction and positive Romberg test. He also had mouth twisting but no other involvement of other cranial nerves. Hearing acuity was normal.

Schwannoma benigno del nervio infraorbitario: reporte de un caso y revisión de la literatura / Infraorbital nerve benign Schwannoma: a case report and review of the literature

Los schwannomas son tumores de naturaleza benigna o maligna, originados a partir de las células de Schwann de la vaina de mielina de nervios periféricos, autónomos y pares craneanos. Dentro de estos últimos, el nervio trigémino es el segundo en frecuencia en ser afectado. Se presenta el caso de una paciente de 33 años portadora de una neuralgia trigeminal izquierda típica de 4 meses de evolución, con un estudio imagenológico que muestra un tumor originado del nervio infraorbitario izquierdo. Se practica exéresis de la lesión, cuyo estudio histológico revela un schwannoma benigno del nervio infraorbitario. No existen casos con afectación de este nervio publicados a la fecha en la literatura internacional que se ha revisado.

Schwannomas are benign or malignant tumors that arise from Schwann cells in the myelin sheath of peripheral, autonomic or cranial nerves. Among the latter, involvement of the trigeminal nerve is usually the second in frequency. We report the case of a 33 year old patient presenting with a left trigeminal neuralgia of 4 month of evolution. The imaging study showed a tumor of the left infraorbital nerve. The lesion was excised, and the histological study revealed a benign Schwannoma of the infraorbital nerve. To our knowledge, this is the first report of this nerve being affected.

Metastasis to the unilateral oculomotor nucleus complex: case report

O presente relato descreve um homem de 76 anos que, após cirurgia de câncer de pulmão apresentou paralisia oculomotora extrínseca à esquerda e paralisia contralateral do músculo reto superior, além de ptose palpebral bilateral. O exame de ressonância magnética evidenciou uma rara situação caracterizada por metástase isolada na região do núcleo do terceiro nervo craniano esquerdo provavelmente comprometendo o sub-núcleo do reto superior e o núcleo central caudal, justificando assim o envolvimento óculo motor bilateral.

Cervical vagus nerve schwannoma

Schwannomas arising from cervical cranial nerves rarely present as neck swelling. Ultrasonography, computerised tomography, magnetic resonance imaging and fine needle aspiration cytology are helpful in reaching a diagnosis. Surgical excision is the treatment of choice. A case of large cervical vagus nerve schwannoma occurring in a young lady is presented with its management

A Case of Retroperitoneal Schwannoma of the Vagus Nerve / 대한소화기학회지

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.

Primary melanoma of Meckel's cave: case report

Apresentamos um caso de neuralgia do trigêmeo com investigação radiológica de ressonância magnética (RM) e tomografia computadorizada apresentando resultado normal. A dor não apresentou alívio com carbamazepina, sendo indicado descompressão microvascular do trigêmio. Passados dois meses, o paciente queixava-se de dor com intensidade similar à do pré-operatório. Nova RM mostrou lesão expansiva no cavo de Meckel, a qual foi tratada cirurgicamente por abordagem extra-dural. O exame anatomopatológico foi compatível com melanoma primário. O seguimento radiológico, após seis meses da cirurgia, não apresentou anormalidades.

Glossopharyngeal schwannoma : a case report and review of literature.

We report a rare case of glossopharyngeal schwannoma whose clinical presentation and the radiological work up suggested an acoustic schwannoma. The diagnosis was made at surgery, once attachment to ninth cranial nerve was seen. The clinical presentation, radiological features and surgical findings of the glossopharyngeal schwannoma are presented along with the review of literature.

Multiple myeloma presenting as proptosis and sixth nerve palsy.

Cranial and intracranial locations are rare in multiple myeloma (MM). But their occurrence has a particular significance. Proptosis and 6th nerve palsy is very uncommon presentation. We report a case of MM with presenting features as proptosis and 6th nerve palsy.

Trigeminal schwannoma associated with pathological laughter and crying.

A 46 year old man with trigeminal schwannoma displayed symptoms of ataxia with pathological laughter and crying. The tumour developed in the cerebellopontine angle, compressing the pontomesencephalic structures backward, extending in the posterior parasellar region and Meckel's cave. No recurrence of laughter and crying attacks were noted after total removal of the tumour. Theories of mechanism of pathological laughter and crying reported in the literature are reviewed.

Metastatic sweat gland carcinoma.

Sweat gland tumours are very rare. They lack distinctive clinical features and the histological appearences are often varied. Hence, diagnosis is difficult and usually late. We report a case of sweat gland adenocarcinoma with bony and lymphnode metastases, and possibly secondary involvement of 7th cranial nerve. This is probably the first case in Indian literature.